ReSPECT - the emergency care planning tool

A new tool has been developed to help nurses discuss with a patient the care they may wish to receive in an emergency, including cardiopulmonary resuscitation (CPR).

Essential facts

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) creates recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices.

The form has been developed in the light of concerns about Do Not Attempt Resuscitation decisions and documents.

Focusing only on withholding CPR from people who are dying or for whom CPR would offer no benefit has resulted in misunderstandings and poor communication and documentation, stakeholders say.

The latest version of the Resuscitation Council’s guidance, Decisions Relating to CPR, calls for more advance planning, good communication, shared decision-making and good documentation.

The ReSPECT approach aims to support this by encouraging patient and family involvement in decision-making, and for recommendations about CPR to be considered in the context of broader plans for emergency care and treatment. The form is used to record the resulting recommendations, which can be used by health and care professionals across the UK.

The straightforward two-page form has been developed by a group of more than 40 stakeholders including the RCN, the National Council for Palliative Care and the Marie Curie charity for people with terminal illness.

It states whether the patient has expressed a wish for care to focus on life-sustaining treatment or on symptom control, and will record clearly whether or not they would like CPR to be carried out.

Health professionals fill in the form during discussions with a patient. While suitable for anyone, it is expected to be particularly relevant for those with complex health needs, nearing the end of their life and at risk of sudden deterioration or cardiac arrest.

ReSPECT is currently being piloted as part of a three-year study, and nurses should not expect to use the process until it has been established in their local area.

Implications for nurses

Following the ReSPECT process involves a discussion with a patient covering:

• The patient's current health and how it may change in the future.
• Identifying preferences for and goals of care in an emergency.
• Agreeing if the focus of care is more on life-sustaining treatments or prioritising comfort.
• Making and recording shared decisions about specific types of care and realistic treatment that they would or would not want considered. Nurses should explain sensitively advanced decisions about treatments that clearly would not work.
• Reaching and making a record of a shared decision about whether or not CPR is recommended

EXPERT COMMENT

‘The ReSPECT approach promotes a supportive discussion between people and healthcare professionals on what they may or may not want in case of a future emergency. It helps support best practice by encouraging and recording discussions that should already be taking place. We want to get away from situations in which people feel they or their relatives have been refused treatment or that CPR decisions have been made without proper discussion.

‘DNA (do not attempt resuscitation) forms are just about resuscitation, and advance planning documents tend to be specific to a particular disease, but the ReSPECT form can be used to record the wishes of anyone. It has been developed with a lot of input from patients, carefully thought out, and the feedback we are getting so far is that it is a user-friendly form.’

Find out more

ReSPECT

Resuscitation Council

Decisions Relating to CPR guidance

RCNi articles

Caring for people who are dying: priorities at the end of life (Nursing Standard, 2015)

Do not resuscitate: reflections on an ethical dilemma (Nursing Standard, 2007)